Ramblings of an Emergency Physician in Texas

Archives for July 10, 2004

Two are given tonight, the luckiest in a bad situation (LABS), and the dumbest aquatic act this summer (DAAtS).

LABS: adult male, who was getting ‘on his face’ at gunpoint, when the criminal actually shot him. An in and out wound of the skin of the shoulder (just like in the movies, no muscle involved), and a bullet wound between his eyes from the ricochet of the round off the ground. I took the flattened little chunk of metal out of his forehead and handed it to the nice officer taking pictures. The victim/patient had no other injuries and went home. I think he got tired of me telling him how lucky he was.

DAAtS: young and dumb, several times the legal alcohol limit, on a jet ski at 1 AM: what could possibly go wrong? Well, the dock is hard to see, it seems, and he hit it at speed.

He had the proverbial sucking chest wound, and had his life saved by some EMT’s and this cool thing, which I didn’t know existed (it’s an adhesive dressing and a Heimlich valve in one combination; terrific gadget). I could see his lung under the dressing, and that’s bad, because that means some chest wall is missing. It’s probably still on the dock. He’ll most likely be fine, but he’s going to hurt for a few days.

During my residency a few years back, I had a patient I will never forget. She had about 400 complaints, but when pressed she said mostly she was there to get her blood pressure checked.

She was the most manic a person can be and still function, though she denied any history of mania. “I’m always like this” was her response to questioning about her pressured speech. She was very knowledgable about health care, and may have been a nurse, but I cannot recall.

I left her for a moment, promising to return, after about 15 minutes of non-stop, stream of consciousness speech. When I came back, reassurring her she was going to be OK (her BP was fine), she was effusive in her praise, and gave me one of the several pictures she’d been drawing during her visit.

A picture is now worth a thousand thoughts, as well. It’s probably not work safe, in that you won’t get fired, but you will be remembered.